COMPUTER PREDICTS AS WELL AS PHYSICIANS

A specialized computer program was able to predict which critically ill patients would live and which would die as well as a group of physicians, a new study has found.

The study evaluated 366 patients admitted to the medical intensive-care unit at Detroit Receiving Hospital. The predictions by members of a team of 57 physicians and 33 critical-care nurses on whether the patient being treated would live were compared with the predictions of a special computer program using 11 pieces of clinical information collected from the same patients.

Researchers led by Dr. James Kruse, assistant professor of medicine at Wayne State University, concluded that there was no ''significant difference'' in the accuracy of the doctors and nurses as compared with the APACHE II system.

Both were ''highly predictive'' of outcome, Kruse wrote in a report on the study published by the Journal of the American Medical Association.

The study is the first to compare the ''objective'' workings of a computer system against ''subjective'' physician judgment in real-time work with patients with such a wide variety of illnesses.

''There`s been a running debate among physicians saying that you could never establish a system that could take in . . . the complexity of clinical practice,'' said Gloria Ruby, senior policy analyst at the federal Office of Technology Assessment. ''He (Kruse) has said, `Look, we`ve done it.` ''

The Kruse study has important implications both clinically and for health policy. Although the APACHE II system is not reliable enough to use alone to make judgments about individual patients, it provides a yardstick for comparison with the physician`s diagnosis.

''Physicians are prone to make certain kinds of errors, and in the future this may be one of the things physicians incorporate into their decisions, like X-rays,'' said Dr. Marc Silverstein, a former assistant professor at the University of Chicago Medical School who studied the Kruse research.

An objective system also could help physicians identify which patients will benefit from intensive care, which is far more expensive than ordinary hospital treatment.

''If a person has a 99 percent chance of dying, is it worth it to society to invest that extra money?'' Kruse asked in an interview.

More broadly, the search for reliable ''objective'' measures of quality has been spotlighted by debate on whether patients are being hurt by the efforts of government and private insurers to restrain medical costs.

''I think the importance of this study is that the (APACHE II) model we`re using is good, but it`s pretty crude compared to what we`re going to be able to do in the future,'' he said.

''We do as well now as experienced physicians do, using everything in their years of experience,'' added Knaus, director of the intensive-care research unit at George Washington University Medical Center. ''That`s remarkable.

Knaus is testing an APACHE III system in 40 hospitals across the country. The initials stand for Acute Physiology and Chronic Health Evaluation.

The physicians involved in the Detroit study were interns, residents and fellows. There was no information on the cases in which physician judgment differed substantially from that of the APACHE II system.

In March, researchers studying results at six hospitals reported that a computer protocol to predict whether or not a patient was having a myocardial infarction, or heart attack, would have reduced unnecessary admissions to a coronary care unit by 11.5 percent without turning away patients who needed to be there.

However, the Detroit study by Kruse was the first to involve a broad range of conditions, including stroke, seizures, heart attacks, pneumonia, respiratory failure and shock.